That's just a fancy name for self insurance, i.e. no insurance. Somehow wrapping it in yet another siloed tax advantaged vehicle makes it sound better.
Of course. Even with a run-of-the-mill HSA + HDHP, you're basically partially self-insured and tasked with the thankless job of insurance administration. You can see there is something scammy about these things (in practice if not on paper) when they are so enthusiastically pushed by the healthcare industry.
You can be interested in the prices, but you won't find anyone interested in telling you the prices. You will also be met with complete incredulity when you ask about prices. (If you're asking about prices for a procedure or treatment related to your child you will also be shamed for "putting a price" on your child's health.)
Adding to this: Oftentimes there isn't a single person in the place that even knows what X costs...and hasn't a clue how to determine that number.
Years ago, I was between jobs and asked for the 'cost'. The reply I got was "$20", a typical copay at the time. When I explained my situation and was asking for the actual out the door costs...20 bucks. They really didn't even understand how to approach my question (could see it in their eyes/response). When I asked for another person in the office - 20 bucks. Hell, even the Dr told me 20 bucks. The bill I received was not 20 bucks - surprise surprise. And what could I do really - hold them to the 20 bucks? Where was my 'proof'...
Many of the people doing the admin work simply are not trained nor equipped to understand the gravity of the position. They can set you up on a calendar and fill out a postcard - beyond this, and there's problems. And why should they? They are being paid to be calendar/postcard filling person only.
The system itself was designed weirdly to begin with, it assumes that you are a wage earner of a large company that is paying insurance as an employment perk. If you deviate from this model - then these sub-systems don't know what to do.
They know what to do. But they are selectively "dumb." Do you think a doctor who runs a clinic and their employees, accountants, medical procedure coders, and insurance claims people don't know a thing or two about costs? How do they stay in business?
But if they told you some four-digit number you'd bolt.
We like to hold medical professionals in high esteem, but these days it's also a business transaction. They know this. As such they are very much a part of this very large problem.
Sure, but that requires a level of investment and effort that a lot of people simply don't have.
The last thing I personally want to do is have to argue with insurance companies and negotiate prices down through the labyrinthine healthcare system after dealing with enough nonsense at work. Even worse if I have to do said negotiation from a hospital bed due to an unforeseen problem, as most health issues tend to be.
when I need something, I usually don't have much luxury to 'shop around', and whatever price shopping you may want to try to do is often still hamstrung by 'in network' vs 'out of network' price tables.
I needed a procedure that was going to be ~$1500 at any one of a half dozen places within a 90 minute drive; some were a bit cheaper, but they couldn't see me for more than a month. There were a couple places that were ~$1100, but it basically would have been a whole day's enterprise for 2 people to get me there and back. To save maybe $400. $400 is not nothing, but I wasn't even actually 100% sure their pricing would actually be what we finally paid - no one could guarantee that. So we may have had 2 people take an entire day from earning on the partial chance of saving some money. Might even have been cheaper in another state, but then you've got travel/hotel costs to add as well.
"...no one could guarantee ..." Key phrase to be sure.
Many people that I know talk about how people need to know how much something costs - but these systems themselves don't know how much anything costs.
Furthermore, they know this and therefore unwilling to guarantee anything.
Knowing prices is great, but I feel is a non-starter when thinking about how the system can be 'fixed'. Also, you can't price shop when you're having a stroke.
All in all, we have to just acknowledge that the system for everyone is broken - beyond this, I haven't a clue as to the next step.
> Also, you can't price shop when you're having a stroke.
And you can't consent to anything when you're having a stroke, or in a car crash, or having surgery, etc. You're hit with thousands of dollars of bills when you're unconscious or not mentally competent, and it can stick with you for years.
Price shopping to keep costs down - yes, fine, it's a nice little component that would probably help a portion of our medical ecosystem. If I can save $14 on some particular medication by choice of pharmacy - sure, why not?
I've maintained for years - either single payer, and/or have insurance go to a primarily individual/family policies that people purchase themselves - get the employers out of my business. People are tied to jobs due to insurance concerns - employer-provided health insurance contributes to labor immobility. Employers have less incentive to hire less healthy people, likely keeping some people from improving their lives.
Remove 'tax deduction' for employers to provide health insurance. Ensure all taxpayers can fully deduct 'health insurance' costs from taxable income, starting from $0 (none of this 7% of MAGI bullshit). OR... increase it? 150% of your premium is deductible in year 1. 130% year 2. 115% year 3. 110% year 4. 100% year 5. Incentivize people to actually own this.
We had 18 months of "let insurance companies sell across state lines" BS during our last election. It's already possible between many states - it's simply far too much regulatory burden to deal with for most companies, that's why most aren't doing anything about it, even when they can.
REAL reform would be changing who actually pays for it - let them become the real 'consumer/customer'. An employers' incentives and mine don't always align, and if they're paying the bill...
